1. We studied diaphragm function in a total of 64 normal subjects, who had no past or present respiratory neuromuscular impairment. 2. measured transdiaphragmatic pressure (Pdi) during maximal sniffs and compared these values with Pdi static inspiratory efforts (PImax.). 3. The range (82-204 cm H2O) better defined lower limits than PImax. (16-164 higher mean value : + sd for was 137 28 H2O 90 37 H2O. 4. reproducibility sniff assessed eight randomly chosen subjects over 3 days: the...

Objective In the critically ill, respiratory muscle strength usually has been assessed by measuring maximum inspiratory pressure. The maneuver is volitional, and results can be unreliable. nonvolitional technique of bilateral anterolateral magnetic stimulation phrenic nerves, producing twitch transdiaphragmatic pressure, successful in normal subjects ambulatory patients. this study we used intensive care unit explored measurement endotracheal tube pressure as a less invasive to assess...

There is no nonvolitional method of assessing quadriceps strength which both supramaximally activates the muscle and acceptable to subjects. In 10 normal subjects patients with suspected weakness we used magnetic stimulation femoral nerve elicit an isometric twitch measured tension (TwQ), surface electromyogram in addition maximum voluntary contraction force (MVC). Supramaximality was achieved all at a mean 83% stimulator output. When supramaximal, TwQ reproducible (mean coefficient...

Thirty patients with breathlessness and diaphragm weakness were studied by measuring transdiaphragmatic pressures during maximal inspirations to total lung capacity, static inspiratory efforts from residual volume, sniffs functional capacity. Maximal respiratory mouth also recorded, rib cage abdominal movements monitored pairs of magnetometers. Sniff pressure was abnormally low in all correlated other maneuvers, pressures. There no relationship between the severity dyspnea group as a whole....

Few data exist concerning expiratory muscle function in amyotrophic lateral sclerosis (ALS). We studied 26 patients with ALS (16 respiratory symptoms and 10 without) measured the maximal static mouth pressure (MEP), gastric during a cough (Cough Pga), after magnetic stimulation of lower thoracic nerve roots (Tw Pga). These measurements were related to ability generate transient supramaximal flow (cough spikes), arterialized capillary blood gases, inspiratory strength. Vocal cord motion was...

Global respiratory muscle strength was studied in 22 normal healthy volunteers during a 4-month winter period. Twelve subjects developed naturally acquired upper tract infections. Maximal static expiratory and inspiratory mouth pressures fell significantly these The greatest falls were documented between the third seventh days of clinical illness. Full recovery occurred by fourteenth day. We conclude that significant abnormalities function can occur infections otherwise young adults.

Bronchial provocation tests performed on two seperate occasions in a farmer with dust from his own grain led to immediate and late respiratory reactions followed, without further exposure dust, by severe during subsequent nights. Studies of lung function, including measurements closing volume, suggested that both large small airways rather than parenchyma were primarily involved. Examination the samples together results skin serologic mite, Glycyphagus destructor, might be an important...

Reduced respiratory muscle strength has been reported in chronic heart failure (CHF) several studies. The data supporting this conclusion come almost exclusively from static inspiratory and expiratory mouth pressure maneuvers (MIP, MEP), which many subjects find difficult to perform. We therefore performed a study using measurements that are less dependent on patient aptitude also provide specific diaphragm strength. In 20 male patients 15 control we measured MIP MEP as well esophageal...

Global respiratory muscle function and diaphragmatic strength were assessed compared with quadriceps femoris in 17 patients generalized mild-to-moderate myasthenia gravis breathlessness. Initial measurements, made 10 h after the last dose of oral anticholinesterase therapy, demonstrated reduced maximal static expiratory (52.4 ± 26.8% predicted) inspiratory (54.0 23.5% mouth pressures 16 patients, all cases. Vital capacity (VC) (70.9 19.0% was abnormal 12 patients. Transdiaphragmatic pressure...

Abstract Objective The Sepsis‐3 task force recommends the use of quick Sequential Organ Failure Assessment (qSOFA) score to identify risk for adverse outcomes in patients presenting with suspected infection. Lactate has been shown predict aim study is investigate utility a post hoc lactate threshold (≥2 mmol/L) added qSOFA (LqSOFA (2) score) primary composite (mortality and/or ICU stay ≥72 h) ED sepsis. Methods Retrospective cohort was conducted on merged dataset or proven sepsis across...

Kyroussis, Dimitris, Gary H. Mills, Michael I. Polkey, Carl-Hugo Hamnegard, Nicholaos Koulouris, Malcolm Green, and John Moxham. Abdominal muscle fatigue after maximal ventilation in humans. J. Appl. Physiol. 81(4): 1477–1483, 1996.—Abdominal muscles are the principal of active expiration. To investigate possibility abdominal low-frequency humans, we stimulated nerve roots supplying muscles. We used a magnetic stimulator (Magstim 200) powering 90-mm circular coil studied six normal subjects....

Sniff esophageal pressure (Pes) is a useful measurement of global inspiratory muscle strength, although it does require passage an balloon. We investigated the relationship between nasopharyngeal (Pnp) or within mouth (Pmo) and Pes during maximal sniff from FRC without noseclip. measured Pes, Pnp, Pmo simultaneously in 10 normal volunteers, 12 patients with weakness. In both groups, Pnp were slightly less but very close to Pes. mean ratio Pnp/Pes was 0.92 +/- 0.006 (mean SE) Pmo/Pes 0.95...

Every year thousands of doctors and scientists fly to meetings at distant locations. <b>Malcolm Green</b> argues that this is no longer justifiable or necessary, but <b>James Drife</b> (doi: 10.1136/bmj.a351)believes face contact hard replace

Malcolm Green revisits an 1848 study of cod liver oil in the treatment tuberculosis The Royal Brompton Hospital is well known for studies evaluating use streptomycin and other chemotherapy tuberculosis (TB) 1940s to 1960s, but it less widely that physicians at hospital were already investigating treatments TB 100 years earlier. This a report conducted 1848. Fig 1 Consumption Diseases Chest, Brompton In their report, medical officers felt duty bear testimony judgement evinced selection...

In 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals. The challenge was to design and implement effective sustainable safety-net system all 225 NSW CEC's designed collaboration with a broad coalition of partners, including clinicians, managers, administrators collaborating agencies. A five-element comprising governance, standard calling criteria observation charts, two-level...

Functional magnetic stimulation (FMS) of the thoracic nerve roots to simulate cough has been suggested as a treatment approach in patients unable voluntarily activate abdominal muscles. However, factors that could influence efficacy FMS clinical use have not evaluated. In present investigation we studied train length, posture, and frequency determine optimal protocol. We also evaluated valve at mouth enhance glottic function investigated whether lung volume time would tension generated by...

The effect of stimulus frequency on the in vivo pressure generating capacity human diaphragm is unknown at lung volumes other than functional residual capacity. transdiaphragmatic (Pdi) produced by a pair phrenic nerve stimuli may be viewed as sum Pdi elicited first (T1 Pdi) and second (T2 stimuli. We used bilateral anterior supramaximal magnetic stimulation digital subtraction technique to obtain T2 interstimulus intervals 999, 100, 50, 33, 10 ms eight normal subjects between volume total...

Complete foreign body airway obstruction is a life-threatening emergency, but there are limited data on its epidemiology.We conducted retrospective analysis of collected routinely from London Ambulance Service calls coded as being for choking was undertaken the calendar year 2016.There were 1916 episodes significant severity to call emergency assessment in during 2016, 0.2% total requiring an ambulance response, average 5.2 per day. The incidence increased at extremes age. Calls occurred...

Maximal relaxation rate (MRR, % pressure fall/10 msec) of the inspiratory muscles is reduced with fatigue. We have investigated whether MRR esophageal (Pes) generated by voluntary sniffs decreased fatigue, and sniff nasopharyngeal (Pnp) mouth (Pmo) reflect these changes. In 10 normal subjects, control Pes correlated closely to Pnp (r = 0.977, p < 0.001) Pmo 0.947, 0.001). To produce muscle four highly motivated subjects breathed exhaustion (3 6 min) through a high resistance. was determined...

Objectives We investigated specific lactate thresholds for adverse outcomes in patients presenting to emergency departments (EDs) with suspected sepsis identified based on the performance of a screening algorithm. Design and setting A standardised bundle was implemented across public hospitals New South Wales, Australia, as quality improvement initiative. register all adult ED presentations (≥18 years) meeting predefined criteria created, using combination data linkage direct reporting from...

Background Sepsis is a significant cause of morbidity and mortality worldwide. Early detection sepsis followed promptly by treatment initiation improves patient outcomes saves lives. Hospitals are increasingly using computerized clinical decision support (CCDS) systems for the rapid identification adult patients with sepsis. Objective This scoping review aims to systematically describe studies reporting on use evaluation CCDS early inpatients Methods The protocol this was previously...